Diagnostic Performance of Single-Photon Emission Computed Tomography/Computed Tomography in Aseptic Loosening: A Systematic Review and Meta-Analysis

Peng, Zhan; Jia, Yukun; Jin, Li; Wang, Guangye

doi:10.1016/j.arth.2021.06.018

Cited by 5 publications

(5 citation statements)

References 26 publications

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“…The present systematic review included a broader spectrum of diagnostic studies focusing only on painful, noninfected knees after knee arthroplasty. With a medium risk of bias according to the QUADAS-2 tool, this review showed high heterogeneity between the studies, similar to previous reports [ 26 , 27 ].…”

Section: Discussionsupporting

confidence: 86%

“…As mentioned above, few systematic reviews related to this topic have been published, and although the results reported in this current review are similar to previous reports [ 27 ], it is possible to identify some differences and strengths that can add significant value to the previously published data. First, the results came exclusively from a population with aseptic painful knee replacement with a larger sample size of patients who could be gathered for the analysis.…”

Section: Discussionsupporting

confidence: 84%

“…For example, Barnsley et al [ 26 ] compared the accuracy of different techniques (bone scan, SPECT/CT, 18-FDG-PET) in the detection of aseptic loosening and found that SPECT/CT arthrography had the best performance; however the results for SPECT/CT were obtained just from two studies comprising 61 patients: sensitivities of 0.75 (femur), 0.86 (tibia) and 1.00 (global result in one study) sensitivities of 0.63 (femur), 0.86 (tibia) and 0.93 (global result in one study) were reported, but the authors did not calculated pooled estimates. Peng et al [ 27 ] evaluated the diagnostic performance of SPECT/CT in assessing prosthetic loosening after hip or knee replacement. Their results, although collected from gathering hip and knee replacement studies, were similar to the ones reported in this systematic review, including an AUC of 0.97, a pooled sensitivity of 0.94 (0.90–0.96) and a pooled specificity of 0.89 (0.78–0.95).…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, most of the current evidence is from observational cohort studies, and few studies examining diagnostic accuracy have been published. To date, published systematic reviews related to painful arthroplasty are scarce: Barnsley et al [ 26 ] analysed two studies that used SPECT/CT as an index test (sensitivity 0.86, specificity 0.93); Peng et al [ 27 ] reported an analysis of sixteen papers; however, they did not separate the results for knee and hip prostheses. Verberne [ 28 ] conducted an analysis regarding the intra- and interobserver agreement of different nuclear medicine techniques in septic and aseptic symptomatic hip and knee replacements.…”

Section: Introductionmentioning

confidence: 99%

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The role of SPECT/CT in painful, noninfected knees after knee arthroplasty: a systematic review and meta-analysis—a diagnostic test accuracy review

Anzola

Hernandez

Rodríguez³

et al. 2023

J Orthop Surg Res

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Purpose The aim of this systematic review was to present the current evidence on the clinical use of single-photon emission computed tomography/computed tomography (SPECT/CT) in the evaluation of noninfected painful knees after knee arthroplasty. Methods Embase, PubMed, Google Scholar, Ovid, Scopus, Science Direct and the Cochrane Database of Systematic Reviews were searched from database inception to May 2022 following the PRISMA guidelines. As a primary outcome, we defined the role of SPECT/CT in the diagnostic approach to noninfected painful knee arthroplasty; as a secondary objective, we described the noninfection-related factors linked to painful knee arthroplasty. Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio values and other indicators were calculated; receiver operating characteristic (ROC) curve analysis results and a summary of the areas under the curve (AUCs) from the included studies were reported. A Fagan plot, likelihood ratio plot and Deeks’ funnel plot were generated and analysed. Methodological quality was assessed using the QUADAS-2 tool, and the certainty of evidence was assessed by the GRADE approach. Results A total of 493 publications were identified, of which eight met the inclusion criteria, with a final pooled sample size of 308 patients. The pooled sensitivity and specificity of SPECT/CT in diagnosing the source of pain in painful knee prostheses were 0.86 (95% CI: 0.75–0.93) and 0.90 (95% CI: 0.79–0.96), respectively, with pooled +LR and −LR values of 8.9 (95% CI: 4.11–19.19) and 0.15 (95% CI: 0.09–0.28). The pooled diagnostic odds ratio was 57.35, and the area under the curve was 0.94. SPECT/CT highly accurately identified different sources of pain, such as loosening of the prosthetic components, patellofemoral overloading, instability, malalignment of the components and degeneration of the patellofemoral compartment. The confidence of the estimates was moderate according to the GRADE approach. Conclusion With demonstrated high sensitivity and specificity, as a diagnostic tool, SPECT/CT can identify the source of pain in painful knees after knee arthroplasty, particularly in cases of loosening, patellofemoral disorders and component malalignment (level of evidence III). These findings have significant clinical repercussions, such as in changing the initial diagnosis, identifying or excluding different causes of painful knee arthroplasties, guiding subsequent treatment and positively impacting the final clinical outcome. We moderately recommend the use of SPECT/CT for identifying the source of pain after knee arthroplasty according to the GRADE assessment. This review was preregistered in Prospero under code CRD42022320457.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The role of SPECT/CT in painful, noninfected knees after knee arthroplasty: a systematic review and meta-analysis—a diagnostic test accuracy review

Anzola

Hernandez

Rodríguez³

et al. 2023

J Orthop Surg Res

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show abstract

“…Indeed, aseptic loosening is often only confirmed intra- or postoperatively, with the preoperative assessment frequently being a misdiagnosis of a low-grade infection [ 27 ]. Several radionuclide imaging techniques—scintigraphic [ 28 , 29 ] and tomographic [ 30 , 31 , 32 ]—have been implemented to provide more conclusive diagnoses of aseptic loosening [ 24 ]; radionuclide imaging has also been used to detect periprosthetic joint infection with reasonable success, but these advanced imaging techniques are time-consuming and only available at specialist centres.…”

Section: Introductionmentioning

confidence: 99%

Passive Biotelemetric Detection of Tibial Debonding in Wireless Battery-Free Smart Knee Implants

Hall,

Cegla,

van Arkel

2024

Sensors

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Aseptic loosening is the dominant failure mechanism in contemporary knee replacement surgery, but diagnostic techniques are poorly sensitive to the early stages of loosening and poorly specific in delineating aseptic cases from infections. Smart implants have been proposed as a solution, but incorporating components for sensing, powering, processing, and communication increases device cost, size, and risk; hence, minimising onboard instrumentation is desirable. In this study, two wireless, battery-free smart implants were developed that used passive biotelemetry to measure fixation at the implant–cement interface of the tibial components. The sensing system comprised of a piezoelectric transducer and coil, with the transducer affixed to the superior surface of the tibial trays of both partial (PKR) and total knee replacement (TKR) systems. Fixation was measured via pulse-echo responses elicited via a three-coil inductive link. The instrumented systems could detect loss of fixation when the implants were partially debonded (+7.1% PKA, +32.6% TKA, both p < 0.001) and fully debonded in situ (+6.3% PKA, +32.5% TKA, both p < 0.001). Measurements were robust to variations in positioning of the external reader, soft tissue, and the femoral component. With low cost and small form factor, the smart implant concept could be adopted for clinical use, particularly for generating an understanding of uncertain aseptic loosening mechanisms.

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Femoral Component Debonding Frequently Missed on Advanced Imaging Prior to Revision of a Recalled Total Knee Arthroplasty

Borsinger,

Chandi,

Belay

et al. 2024

The Journal of Arthroplasty

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Diagnostic Performance of Single-Photon Emission Computed Tomography/Computed Tomography in Aseptic Loosening: A Systematic Review and Meta-Analysis

Cited by 5 publications

References 26 publications

The role of SPECT/CT in painful, noninfected knees after knee arthroplasty: a systematic review and meta-analysis—a diagnostic test accuracy review

The role of SPECT/CT in painful, noninfected knees after knee arthroplasty: a systematic review and meta-analysis—a diagnostic test accuracy review

Passive Biotelemetric Detection of Tibial Debonding in Wireless Battery-Free Smart Knee Implants

Femoral Component Debonding Frequently Missed on Advanced Imaging Prior to Revision of a Recalled Total Knee Arthroplasty

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